title: Increasing utilisation of emergency ambulances.
abstract: BACKGROUND
  Increased ambulance utilisation is closely linked with Emergency Department (ED) attendances. Pressures on hospital systems are widely acknowledged with ED overcrowding reported regularly in the media and peer-reviewed literature. Strains on ambulance services are less well-documented or studied.
  
  
  OBJECTIVE
  To review the literature to determine the trends in utilisation of emergency ambulances throughout the developed world and to discuss the major underlying drivers perceived as contributing to this increase.
  
  
  METHODS
  A search of online databases, search engines, peer-reviewed journals and audit reports was undertaken.
  
  
  RESULTS
  Ambulance utilisation has increased in many developed countries over the past 20 years. Annual growth rates throughout Australia and the United Kingdom are similar. Population ageing, changes in social support, accessibility and pricing, and increasing community health awareness have been proposed as associated factors. As the extent of their contribution has not yet been established these factors were reviewed.
  
  
  CONCLUSIONS
  The continued rise in utilisation of emergency ambulances is placing increasing demands on ambulance services and the wider health system, potentially compromising access, quality, safety and outcomes. A variety of factors may contribute to this increase and targeted strategies to reduce utilisation will require an accurate identification of the major drivers of demand.
authors.affiliation: Ambulance Victoria, 375 Manningham Road, Doncaster, VIC 3108, Australia. judy.lowthian@monash.edu
authors.forename: Judy A
authors.initials: JA
authors.lastname: Lowthian
authors.forename: Peter A
authors.initials: PA
authors.lastname: Cameron
authors.forename: Johannes U
authors.initials: JU
authors.lastname: Stoelwinder
authors.forename: Andrea
authors.initials: A
authors.lastname: Curtis
authors.forename: Alex
authors.initials: A
authors.lastname: Currell
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Cooke
authors.forename: John J
authors.initials: JJ
authors.lastname: McNeil
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000552:Ambulances / Q000706:statistics & numerical data*; D001315:Australia; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D055815:Young Adult